Enhanced recovery after surgery for sleeve gastrectomies: improved patient outcomes

Sapin, Ari; Hilden, Patrick; Cinicolo, Luciana; Stein, Jenifer; Turner, Amber L.; Pitera, Richard; Yodicei, Paul; Paragi, Prakash R.

doi:10.1016/j.soard.2021.04.017

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…We believe that the widespread application of preoperative testing, monitoring equipments, NIV and other equipments in bariatric centres would result in a significant decrease in the proportion of patients admitted to ICU. ERAS is an important management measure of reducing postoperative hospitalization, costs, and complications 22 , 23 . The first ERAS guideline for bariatric surgery was published in 2016 24 .…”

Section: Discussionmentioning

confidence: 99%

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

Yang,

Hua,

Liu

et al. 2024

International Journal of Surgery

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Background: Performing bariatric surgery on patients with a body mass index (BMI) of over 50 kg/m2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. Materials and Methods: A prospective survey was designed to investigate the perioperative management of patients with a BMI of ≥50 kg/m2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anesthesia, and postoperative management measures. A response from only one attending physician per bariatric center was accepted. Results: Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centers had completed a total of 44,702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3,280 patients had a BMI exceeding 50 kg/m2. The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centers, Roux-en-Y gastric bypass by 11 centers, sleeve gastrectomy plus jejunojejunal bypass by 19 centers, one anastomosis gastric bypass by 1 center, and duodenal switch by 1 center. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centers believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only 3 centers considered using intragastric balloon placement. Postoperative management measures varied greatly. Conclusion: Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m2. The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

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Section: Discussionmentioning

confidence: 99%

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

Yang,

Hua,

Liu

et al. 2024

International Journal of Surgery

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“…In the previous research, we also found that the patients’ satisfaction with treatment was obviously improved after the use of ERAS. [41] But this research did not analyze patient satisfaction, as this index is rarely reported in the articles included in this study.…”

Section: Discussionmentioning

confidence: 99%

Application of enhanced recovery after surgery in perioperative patients undergoing laparoscopic surgery for gastric cancer: A meta-analysis

et al. 2023

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Background: To analyze the effect of enhanced recovery after surgery (ERAS) in perioperative patients undergoing laparoscopic surgery for gastric cancer (GC). Methods: We searched the literature databases of PubMed (https://pubmed.ncbi.nlm.nih.gov/) and Web of Science (https://www.webofscience.com/) for studies related to ERAS and laparoscopic surgery for GC from their inception till October 2022, and the retrieved articles were further screened for analysis. The literature quality was evaluated based on the Cochrane risk of bias tool. The endpoints included the first postoperative exhaust time, first postoperative bowel movement, length of stay, complications and hospitalization expenses. The meta-analysis was performed using RevMan 5.4 software. Results: 11 studies were included, involving 2039 patients. Meta-analysis showed that the first postoperative exhaust and bowel movement were earlier and the length of stay was shorter in the experimental group (e.g.,) than in the control group (CG) (P < .05). Moreover, a lower incidence of complications and markedly reduced hospitalization expenses were determined in for example (P < .05). Due to the heterogeneity in the comparison of indicators such as the first postoperative exhaust and bowel movement across articles, a funnel plot was drawn for observations. The plot was found to be basically symmetrical, indicating small results bias and reliable reference significance of our findings. Conclusion: ERAS for perioperative patients undergoing laparoscopic surgery for GC can effectively shorten the postoperative rehabilitation cycle of patients, improve surgical safety and reduce treatment costs.

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“…Implementing the ERAS in bariatric surgery improved the composite outcome, specifically shorter hospital length of stay and mortality. [ 72 73 ] Sapin et al [ 73 ] investigated the impact of minimizing intraoperative opioids in favor of neuraxial anesthesia, and the postoperative US-guided transverse abdominis plane (TAB) block for sleeve gastrostomies. [ 73 ] The study showed shorter hospital stay by 18%, a decrease in the average use of morphine by 61%, and a decrease in average direct costs per case.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…[ 72 73 ] Sapin et al [ 73 ] investigated the impact of minimizing intraoperative opioids in favor of neuraxial anesthesia, and the postoperative US-guided transverse abdominis plane (TAB) block for sleeve gastrostomies. [ 73 ] The study showed shorter hospital stay by 18%, a decrease in the average use of morphine by 61%, and a decrease in average direct costs per case. However, there was no significant difference in the 30-day readmission rate between the pre-a nd post-implementation period.…”

Section: Regional Analgesiamentioning

confidence: 99%

The role of ultrasonography in anesthesia for bariatric surgery

et al. 2022

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Bariatric surgeries are effective long-term management for morbid obesity with its adverse sequelae. Anesthesia of bariatric surgeries poses unique challenges for the anesthesiologist in every step starting with vascular access till tracheal extubation. The usage of ultrasound in anesthesia is becoming more prevalent with a variety of benefits, especially in the obese population. Ultrasound is successfully used for obtaining vascular access, with more than 15 million catheters placed in the United States alone. Ultrasound can also be used to predict difficult intubation, as it can confirm the tracheal intubation and assess the gastric content to prevent pulmonary aspiration. Ultrasound is also used in the management of mechanically ventilated patients to monitor lung aeration and to identify respiratory complications during positive pressure ventilation. Moreover, intraoperative echocardiography helps to discover the pulmonary embolism and guides the fluid therapy. Finally, ultrasound can be used to perform neuraxial and fascial plane block with a less overall time of the procedures and minimal complications. The wide use of ultrasound in bariatric anesthesia reflects the learning curve of the anesthesiologists and their mounting efforts to provide safe anesthesia utilizing the updated technology. In this review, we highlight the role of ultrasonography in anesthesia of bariatric surgery and discuss the recent guidelines.

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Enhanced recovery after surgery for sleeve gastrectomies: improved patient outcomes

Cited by 13 publications

References 17 publications

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m2 undergoing bariatric surgery in China: a multicenter cross-sectional study

Application of enhanced recovery after surgery in perioperative patients undergoing laparoscopic surgery for gastric cancer: A meta-analysis

The role of ultrasonography in anesthesia for bariatric surgery

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